Hasan S T, Marshall C, Robson W A, Neal D E
Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
Br J Urol. 1995 Nov;76(5):551-7. doi: 10.1111/j.1464-410x.1995.tb07777.x.
To study the long-term outcome of patients undergoing enterocystoplasty.
The study comprised 48 patients (17 men and 31 women; mean age 46 years) who underwent enterocystoplasty for idiopathic detrusor instability (DI, 35 patients) or neurogenic bladder dysfunction (13 patients). Symptoms were scored from 0 to 14 and the overall outcome and generic quality of life were assessed using a Visick grading system (groups A to E) and the Nottingham Health Profile (NHP). These assessments were carried out before, 3 months after operation and at the final follow-up (38 +/- 18 months, range 13-78). Urodynamic studies were performed before and after operation.
No patient died after operation and there was minimal early morbidity. Late complications (> 30 days) included incisional hernia (3), anastomotic perforation (1), calculus formation (1) and urethral stricture (1). Clean intermittent self-catheterization (CISC) was performed by 36 (75%) patients. Early symptomatic outcome was good in 40 (83%) patients, moderate in seven (15%) and unsatisfactory in one (2%) patient. The mean symptom scores before and 3 months after surgery were 10 (range 2-14) and 3 (range 2-14), respectively (P < 0.001). There was a significant increase in total bladder capacity (307 +/- 140 to 588 +/- 217 mL; P < 0.001) and bladder compliance (37 +/- 50 to 169 +/- 162 mL/cm H2O; P < 0.001). DI persisted in 15 (31%) patients. NHP scores revealed significant improvements in all domains. Final assessment showed a less satisfactory situation, with recurrent urinary tract infection (UTI) in 17 (37%) patients, a need for long-term antibiotic therapy in seven (15%) and a change in bowel habit in 15 (33%) (13 DI, two with neurogenic bladder dysfunction). CISC was performed by 39 (85%) patients. The long-term outcome was good or moderate in 12 patients (92%) with neurogenic bladder dysfunction and good or moderate in only 19 patients (58%) with DI.
Clam enterocystoplasty remains an effective management option in some patients with DI, but most patients with neurogenic bladder dysfunction do well. The procedure is, however, associated with long-term complications such as disturbance of bowel habit and recurrent UTIs, which impair the outcome in the long-term in patients with DI despite general improvements in irritative bladder symptoms.
研究接受肠膀胱扩大术患者的长期预后。
本研究纳入48例患者（17例男性和31例女性；平均年龄46岁），这些患者因特发性逼尿肌不稳定（DI，35例患者）或神经源性膀胱功能障碍（13例患者）接受了肠膀胱扩大术。症状评分从0至14分，使用Visick分级系统（A至E组）和诺丁汉健康量表（NHP）评估总体预后和一般生活质量。这些评估在术前、术后3个月及最终随访时（38±18个月，范围13 - 78个月）进行。术前和术后均进行了尿动力学研究。
术后无患者死亡，早期并发症极少。晚期并发症（>30天）包括切口疝（3例）、吻合口穿孔（1例）、结石形成（1例）和尿道狭窄（1例）。36例（75%）患者进行了清洁间歇性自家导尿（CISC）。40例（83%）患者早期症状改善良好，7例（15%）改善中等，1例（2%）患者不满意。术前和术后3个月的平均症状评分分别为10分（范围2 - 14分）和3分（范围2 - 14分）（P < 0.001）。膀胱总容量显著增加（307±140至588±217 mL；P < 0.001），膀胱顺应性也显著增加（37±50至169±162 mL/cm H₂O；P < 0.001）。15例（31%）患者DI持续存在。NHP评分显示所有领域均有显著改善。最终评估显示情况不太理想，17例（37%）患者反复发生尿路感染（UTI），7例（15%）患者需要长期抗生素治疗，15例（33%）患者排便习惯改变（13例DI患者，2例神经源性膀胱功能障碍患者）。39例（85%）患者进行了CISC。12例（92%）神经源性膀胱功能障碍患者的长期预后良好或中等，而DI患者中只有19例（58%）长期预后良好或中等。
对于一些DI患者，原位肠膀胱扩大术仍是一种有效的治疗选择，但大多数神经源性膀胱功能障碍患者预后良好。然而，该手术与长期并发症相关，如排便习惯改变和反复UTI，尽管膀胱刺激症状总体有所改善，但这些并发症会长期影响DI患者的预后。
